Throughout this application various publications are referred to in superscripts. Full citations for these references may be found at the end of the specification before the claims. The disclosures of these publications are hereby incorporated by reference in their entireties into the subject application to more fully describe the art to which the subject application pertains.
Midline axial sternotomy, first described by Milton in 1887 and reintroduced by Julian and Associates in 1957,1 is the most frequently performed osteotomy worldwide2, and is the preferred technique for exposure of the heart and great vessels. Despite its advantages, sternal wound complications may occur. Sternal dehiscence can occur in 0.2% to 5% of patients due to poor wound healing and surgery related factors.3-5 
Sternal dehiscence and deep sternal wound infection (DSWI) are post-sternotomy wound complications that result in significant morbidity and mortality as well as prolonged hospital stay and increased cost to patients who undergo cardiac surgery. The reported prevalence of this complication ranges from 1-5% with reported associated mortality of up to 25%.6,7 While relatively rare, when they do occur these complications can be severe and costly.
Numerous preoperative and operative risk factors have been identified as predictors of DSWI following cardiac surgery. These include obesity, diabetes mellitus, chronic obstructive pulmonary disease, smoking, steroid use, New York Heart Association functional class IV, osteoporosis, immunosuppression, and previous sternotomy. Operative risk factors include bilateral internal mammary artery harvest, prolonged cardiopulmonary bypass time, and transverse sternal fractures.8 Additionally, patients with multiple known risk factors or off midline sternotomy have been identified as high risk for sternal dehiscence.9,10 
Primary reinforcement, an alternative technique to traditional closure by wire cerclage, has been advocated for high-risk patients. Primary sternal plating, stainless steel coils, cables, or recently, a sternal synthesis device are cited as increasing sternal stability and thereby potentially reducing wound infection rates.9,10 The decision to employ alternative techniques and materials depends on the surgeon's ability to identify high risk patients who would benefit from such primary reinforcement. However, alternative techniques to prevent faulty sternotomy have not been thoroughly addressed in the literature. There are no identified patents that address the issue of asymmetric osteotomy of the sternum with a cutting guide. The present invention addresses the need for improved treatment procedures and apparatus.